Causes of RPL

 

Tr of APLA:- LDA preconceptionally and continued after Cardiac activities are  demonstrated  .  One should combine with LMWH or UFH ( some claim better efficacy than LMWH) at the dosage of 5000-10,000  particularly  if administerd  12 hourly.  Some refer to initiate heparin as soon as UPT s +ve but debate exists till date. This is to  be continued in postpartum period to avoid convulsions and thrombosis –VTE if there is superadded factor of thrombophilia . The problem of UFH is that one has to monitor Platelate count on weekly basis for first 2-3 weeks and later on monthly basis  .

Misc tr: To add Calcium 300mg day and Vit D 400 IU daily.

Q. 14:-What are the diff antibodies which may be the  cause RPL but may be the etilogy of

a) FGR/Unexplained IUFD without morphological   defect of foetus and eu karyotype foetus,

 In FGR/Unexplained IUFD one should insist on  anticardiolipin antibody testing .

b) Severe PIH:-Usually Lupus anticoagulant test which may  be +ve and therefore one test is enough.

c) More than 3 losses: - before 10 weeks:-IgG anti-beta- glycoprotein-1.

d) Eclampsia or Vascular thrombosis:- IgM anti-beta- glycoprotein-1.

e) If ANA + ve   :- In general population too such is the prevalence as is the prevalence of RPL ,In such Nave cases no steroids . It doses invite problem to mother.

Immunotherapy may be answer ? To counteract  fatal transplant rejection.  1) Paternal Leukocyte immunization, 2) Trophoblast immune infusion,3)  I V. Intralipid   , however Ry by above three methods   are not supported by  Cochrane Review.

Q.15:- another not uncommon cause of RSA (RPL) is Chr Cervicitis:- Cultureà Doxycycline to both partners 100 mg BD for 2 weeks. On day 11 take a cultureà if not cured then  extend DOXY course for 4 weeks.

If not cured clinically or by culture add Ofoxacilin 300 mg daily for 2 weeks.

Q.16: Thrombotic Disorders excluding aPL related (Non immunological causes of Hypercoagulability).

Second generation cougalation assay:- Thrombophilia screening: Tests for 1) APC(activated Protein C resistance), Factor Leiden V mutation:- 2) prothrombin gene mutation G20210A gene mutation by -PCR  3)Antithrobin Activity:- Normal levels are 75% and 130% 4) Protein S activity= Normally  is 60-145% 5) Protein C activity= Normally 75% to 150%.

 

Q.17:-Genetic cause of RPL:- Parenterally  harboured Translocations, or inversions, deletions or duplications of genetic information  keeping the chromosomal number intact. These changes can be seen also to occur de novo in the embryo.

Chromosomal Errors in parents:- Prevalence amongst general populations 0.7% but amongst cases of RPL parental is 3-5% cases.